Starting at age 20, everyone should have their cholesterol checked at least
every 5 years. Children and teens who have a family history of early heart
disease or total cholesterol above 240 mg/dL should be screened sooner.
A fasting lipid profile (also called lipoprotein profile) is a detailed blood
test for cholesterol. You will need to fast for 9 - 12 hours prior to the test.
This test includes:
- LDL level -- this is the "bad" cholesterol that sticks to your arteries
and can cause blockage.
- HDL level -- this is the "good" cholesterol that helps to prevent
build up in your arteries.
- Triglyceride level -- this is another type of fat in your blood
that can lead to atherosclerosis.
- Total cholesterol
The lipid profile will be done by drawing a blood sample from your arm and
will then be sent to a laboratory for analysis.
For initial screening, your doctor may take a blood sample even if you have
not fasted. In this case, the doctor will look at only the total and HDL cholesterols.
If the total is 200 mg/dL (or above) or the HDL is below 40 mg/dL, the doctor
will also order a fasting lipid profile.
The following charts will help you understand what your blood results mean.
Keep in mind, though, that your underlying risk for heart disease is what gives
these numbers their significance. Virtually all cholesterol levels should be
treated for those at the highest risk.
The term "high" cholesterol generally refers to having high total or high
LDL levels. Remember, your LDL level is usually the one doctors are most
LDL cholesterol levels -- bad cholesterol
According to the National Heart, Lung, and Blood Institute, your LDL cholesterol
level is a better indicator of your risk for a heart attack and stroke than
total cholesterol. The lower your LDL, the lower your risk for heart disease
or stroke. LDL cholesterol less than 100 mg/dL is considered optimal. For some
people with LDL levels below 100 mg/dL, statin drugs may still be very useful
for preventing heart disease. Virtually all cholesterol levels benefit from
treatment in those who are at the highest risk for heart disease. If you
already have heart disease plus another strong risk factor for heart problems,
like diabetes, current cigarette smoking, poorly controlled high blood pressure,
or the metabolic syndrome (high triglycerides, low HDL cholesterol, and obesity), you
should strive to bring your LDL cholesterol below 70 mg/dL.
Women who are at high risk for heart disease should lower their LDL
cholesterol below 70 mg/dL, recommends the American Heart Association.
Treatment recommendations for high cholesterol are based on your LDL levels
and whether or not you already have heart disease or any risk factors for heart
disease. Some people can lower their LDL by making basic diet and lifestyle
changes. These changes include:
- Eating less saturated fat and cholesterol
- Following a weight management program
- Increasing physical activity
Other people will need medication to lower their LDL level, as explained in
Step 7, Cholesterol-lowering drugs.
HDL Cholesterol Levels -- "Good
Women tend to have better HDL cholesterol than men. In general, an increased
risk for heart disease, including heart attack, occurs when the HDL level is
less than 40mg/dL. More specifically, men are at particular risk if their HDL
is below 37 mg/dL and women if their HDL is below 47 mg/dL.
||HDL Cholesterol Levels
|Bad - major risk for heart disease
||Less than 40 mg/dL
|Good - protects against heart disease
||60mg/dL and above
High triglyceride levels may also be associated with a higher risk for heart
disease and stroke. This is especially true because people with high triglycerides
often have other conditions, such as diabetes and obesity, that increase the
likelihood of developing cardiovascular disease.
||Less than 150 mg/dL
||500 mg/dL or above
Total blood cholesterol levels
In general, the lower your total cholesterol the better.
||Total Cholesterol Level
||below 190 to 200 mg/dL
- Your risk for a heart attack is low, unless you have other risk factors.
- You should still eat foods low in saturated fat and cholesterol, and
maintain an adequate level of physical activity.
- Have your cholesterol rechecked in 5 years or sooner for men over 45
and women over 55.
|Borderline High Risk
||200 to 239 mg/dL
- People who fall in this borderline range need to be followed closely.
- Recheck in 1-2 years if you have no other risk factors for heart disease
and your HDL is greater than 40mg/dL.
- Recheck sooner if you have risk factors, including if HDL is less than
- Limit foods high in saturated fat and cholesterol.
- Keep physically active.
||240 or higher mg/dL
- You are at a high risk for a heart attack and stroke.
- Discuss your treatment options and lifestyle changes with your health
- Limit saturated fats and cholesterol in your diet.
- Increase your level of physical activity.
- Take any prescribed medicines consistently.
- Have additional tests, if needed.
Emerging risk factors for coronary
Your health care provider may soon be using other screening tests for coronary
artery disease to guide treatment:
- Total-to-HDL ration -- This may be more predictive of heart risk than total
or LDL cholesterol values.
- Non-HDL ration -- Total cholesterol minus HDL
- Lipoprotein a -- This is linked to higher levels of LDL.
- Small, dense LDL -- The worst kind of LDL
- Apolipoproteins -- Because the amount of cholesterol varies in LDL and
HDL particles, measuring the apolipoproteins directly may be a better indicator
A.D.A.M. Editorial: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Alan Greene, M.D., F.A.A.P., Department of Pediatrics, Packard Children's Hospital, Stanford University School of Medicine; Chief Medical Officer, A.D.A.M., Inc. (10/31/2006)
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